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HomeMy WebLinkAboutZ-14811FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. to Certificate Of Occupancy Z14811 House No. Street Hamle~ County Tax Map No. 1000 Section . . .1.0 ........ Block . . ..0.6 .......... Lot ~/.o., .5 .......... ' Subdivision ............................... Filed Map No ......... Lot No .............. R 'r e t fo 'vte e-f il el 'n built prior ~ Certificate of Occupancy dated . .A.u. qu..s .t... 1. 8. ............... 19.8.6., was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificate is issued to ....E.L.I.Z..A.B.E.T.H., .F....B..L.U.A. ................................... of the aforesaid building. Suffolk County Department of Health Approval .... .N/.A. .................................. UNDERWRITERS CERTIFICATE NO ............ .N././~ .................................. Building Inspector Rev. 1/81 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCC Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building InAoec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features 2. Final approvat of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. 8~vorn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requi~ed to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. Au§u.s.t. ll, 1986 New Buildi~qg ............. Old or Pre-existing Building(X). X - =/Vacant Land ........ Private Road off East End Road Fishers Island Location of Property ............................................... ~ ~ ...... .,--. . House No. Streer Hamlet Elisabeth. 'F. Blua Owner or Owners of Property ................. -.- ~ ~ ................................... 10 6 ~p/o 5 County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept Approval Labor Dept Approval Underwriters Approval ........................ Planning Board Approval .... Request for Temporary Certificate ..................... Final Certificat~ ...... Fee ~ubmitted $ .............................15. O0 Construction on above described building and permit'meets all appl~cable_.co.des and regu at ons. Appli Michael 3. H.all Affidavit of Elisabeth F. Blua State of New York ) County of ~~) ss: The undersigned, Elisabeth F. Blua, being duly sworn, deposes and says that: 1. She is the owner of the property located on Fishers Island, New york, which is described as Lot 1 on the Plan, dated June 2, 1986, as revised June 18, 1986, prepared by Chandler, Palmer & King, on which is located a single-family dwelling. 2. Said single-family dwelling and related improve- ment located on Lot 1 were constructed before April 23, 1957. 3. There have been no subsequent improvements constructed on Lot 1 since April 23, 1957. Elisabeth F. Blua Sworn to before me thisl/V~day of August, 1986. Notary Public Southold, N.Y. 11971 (516) 765-1938 July 17, 1986 Michael J. Hall Attorneys at Law Youngs Avenue Southold, NY 11971 Re: Lot Line Change for Elizabeth Blua Dear Mr. Hall: The following action was taken by the Southold Town Planning Board, Monday, July 14, 1986. RESOLVED that the Southold Town Planning Board approve the lot-line change for Elizabeth Blua located at Fishers Island, survey dated June 18, 1986. Please forward 3 surveys indicating that this is a lot-line change rather then a set-off. Please contact this office if you have any questions. Very truly y~ours, A BENNETT ORLOWSKI, JR. , CHAIRMAN SOUTHOLD TOWN PLANNING BOARD By Melissa Spiro l ~Z ~ .....